Factors Inherent to the Treatment of Borderline Patients

The voluminous literature concerning the borderline syndrome and the frequent scientific meetings devoted to the diagnostic and therapeutic problems posed by the borderline patient attest to the dominant position the syndrome has assumed in psychiatry within the past decade. In order to place my discussion of some factors inherent to the psychotherapy of the borderline patient in perspective, I have chosen to enumerate several principles which are pertinent to and which underly the therapeutic approach.

Recent reviews of the literature (Gunderson and Singer 1975; Stone, 1977) make clear that the borderline syndrome encompasses a continuum of disorders that constitute a broad spectrum. At the less disturbed end of the spectrum are those disorders which resemble the character disorders and neuroses, patients whose superficial social and work adaptation are quite good. At the more disturbed end of the spectrum are those patients who are more vulnerable to brief psychotic episodes, suicidal depressions, and antisocial behavior. Authors who have functioned primarily within hospital settings have understandably emphasized and studied those patients whose pathology most resembles that of the psychoses (pseudoneurotic schizophrenia of Hoch and Polatin, 1949; latent schizophrenia of Bychowski, 1953; and psychotic character of Frosch, 1964). Authors whose experience has been primarily in outpatient settings have described the borderline syndrome in patients who were not prone to disorganization and loss of controls to a degree requiring hospitalization (Stern, 1938; Greenacre, 1952; Deutsch, 1942; and Schmideberg, 1959 to mention